479 - Treatment of Prolonged Post-Operative Bleeding in Pediatric AML Patient

Bates, ME, Vinson, LA. Treatment of Prolonged Post-Operative Bleeding in Pediatric AML Patient (Indiana University Riley Hospital for Children, Indianapolis, IN)

Introduction:   Acute Myeloid Leukemia (AML) accounts for 25% of acute leukemias in children.  AML is a hematopoietic malignancy involving proliferation of abnormal myeloblasts in bone marrow. This disordered differentiation of myeloblasts effects red blood cells, white blood cells, and platelets.  Pancytopenia accompanies these cases and causes related symptoms including fatigue and hemorrhagic findings.  Dental considerations for AML patients are centered around reducing risk of bleeding and infection.

Case Abstract:  Pediatric Dentistry at Riley Children’s Hospital was consulted regarding a 7-year-old male with new diagnosis of Acute Myeloid Leukemia.  The patient had no additional contributory medical history or known drug allergies.  The pediatric dental team was consulted prior to beginning chemotherapy due to multiple carious teeth, including localized gingival abscess on tooth #B. No facial swelling or cellulitis was noted.  The patient’s physicians elected to move forward with comprehensive dental treatment under general anesthesia to address dental infection prior to start of chemotherapy and immunosuppression.  Pre-operative lab values indicate platelets 54 k/cumm, hemoglobin 7.1 GM/dL, and ANC 0.6 k/cumm.  The patient received a transfusion of one-unit pRBCs and one-unit platelets prior to surgery and a 10-day course of IV Cefepime.  In the operating room, the patient received comprehensive dental rehabilitation, including extraction of three posterior teeth.  Chemotherapy treatment began 24-hours after dental treatment with subsequent drop in laboratory values to 33-47 k/cumm in the days following treatment. In the post-operative phase, the patient experienced prolonged bleeding of extraction site #S.  This report will include radiographic findings, laboratory values, and treatment rendered.